Low serum albumin may predict the need for gastric resection in patients with perforated peptic ulcer
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Updated: Mar 22, 2026
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Published on: September 22, 2023
J G Seow1, Y R Lim2, V G Shelat3
1Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore, Singapore.
Insights
Gastric resection (GR) for perforated peptic ulcer (PPU) is needed in 10% of cases. Low serum albumin is a key predictor for requiring GR, which has high morbidity and mortality.
Area of Science:
- Gastroenterology
- Surgical Emergencies
- Peptic Ulcer Disease
Background:
- Perforated peptic ulcer (PPU) is a critical surgical emergency.
- Omental patch repair (PR) is the standard treatment, while gastric resection (GR) is reserved for complex cases.
Purpose of the Study:
- To audit the outcomes of gastric resection (GR) for perforated peptic ulcer (PPU).
- To identify pre-operative factors predicting the need for GR in PPU patients.
Main Methods:
- Retrospective single-institution study of PPU patients from 2004-2012.
- Analysis of demographics, clinical presentation, and intra-operative findings.
- Audit of clinical outcomes and mortality for patients undergoing GR.
Main Results:
- Gastric resection (GR) was performed in 10.4% of PPU cases.
- Low serum albumin was a significant predictor for GR on multivariate analysis (OR 5.57).
- Helicobacter pylori infection showed a protective effect against GR (OR 0.25).
- Morbidity and mortality rates for GR were 27.7% and 24.2%, respectively.
Conclusions:
- Gastric resection (GR) is required in approximately 10% of perforated peptic ulcer (PPU) cases.
- Low serum albumin is a significant pre-operative predictor for the need for GR.
- The morbidity and mortality associated with GR for PPU remain high.
Purpose:
Perforated peptic ulcer (PPU) is a common surgical emergency and treatment involves omental patch repair (PR). Gastric resection (GR) is reserved for difficult pathologies. We audit the outcomes of GR at our institution and evaluate the pre-operative factors predicting the need for GR.
Methods:
This is a single-institution, retrospective study of patients with PPU who underwent surgery from 2004 to 2012. Demographics, clinical presentation and intra-operative findings were studied to identify factors predicting the need for GR in PPU. An audit of clinical outcomes and mortality for all patients with GR is reported.
Results:
537 (89.6 %) patients underwent PR and 62 (10.4 %) patients GR. Old age (p < 0.0001), female sex (p = 0.0123), non-steroidal anti-inflammatory drugs (NSAIDs) usage (p = 0.0008), previous history of peptic ulcer disease (PUD) (p = 0.0159), low hemoglobin (p < 0.0001), low serum albumin (p < 0.0001), high serum creatinine (p = 0.0030), high urea (p = 0.0006) and large ulcer size (p < 0.0001) predict the need for GR. On multivariate analysis only low serum albumin (OR 5.57, 95 % CI 1.56-19.84, p = 0.008) predicted the need for GR. The presence of Helicobacter pylori infection was protective against GR (OR 0.25, 95 %CI 0.14-0.44, p < 0.0001). Morbidity and mortality of GR was 27.7 and 24.2 %, respectively.
Conclusion:
GR is needed in one in ten cases of PPU. Low serum albumin predicted the need for GR on multivariate analysis. Morbidity and mortality of GR remains high.
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